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NPI Code Detail

MEDICARE: BRANDON WAYNE HARRISON

MEDICARE: BRANDON WAYNE HARRISON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramWI

General Provider Information

NPI Number : 1861331357
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON WAYNE HARRISON
Provider Business Mailing Address
First Line : 3021 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number : 920-431-1810
Fax Number :
Provider Business Practice Location Address
First Line : 3021 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number : 920-431-1810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2026
Last Update Date : 03/27/2026

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Directions to “ BRANDON WAYNE HARRISON ” Practice Location

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